I understand that the novel coronavirus causes the disease known as COVID-19. I understand that the novel coronavirus has a long incubation period during which carriers of the virus may not show symptoms and still be contagious.
I understand that by entering Sagesse and being exposed to different environment(s) and others, I may have an elevated risk of contracting COVID-19.
I understand that accessing in-person support through Sagesse while using recommended precautions determined by Alberta Health Services (i.e. hand washing, PPE (personal protective equipment), and maintaining 2-meter distance from others) does not eliminate all risk for contracting COVID-19.
I understand that information and safety precautions surrounding COVID-19 may change at any time therefore impacting policies and procedures to in-person support.
I understand that if I answered “No” to all COVID-19 assessment questions but I am presenting with any symptoms (i.e. Continuous cough, sneeze or others) during in-person support that I will be asked to leave and return only when symptoms are gone and I have a confirmed negative COVID-19 test result.
I confirm that by signing this form I do not have any presenting symptoms of COVID-19 and have not received a positive COVID-19 result in the last 14 days or been in close to contact with anyone who received a positive COVID-19 result in the last 14 days.
I confirm that by signing this form that I understand the risks associated and have voluntarily decided and consent to receive in-person support through Sagesse.
I confirm that by signing this form and/or checking off this box I consent and will adhere to all Sagesse policies and procedures regarding in-person support to the best of my ability, including (but not limited to):
- Temperature check before entering Sagesse office (Sagesse location specific)
- Wearing a Sagesse provided mask and/or face shield at all times when physical distancing is not guaranteed
- Hand washing and/or hand sanitizing upon entering Sagesse and each time I leave and return to Sagesse spaces (Sagesse location specific)